Here’s what Texas families need to know about Medicaid, ACA changes coming soon
Texas is the most uninsured state in America, and now, with new federal policies taking effect and pandemic-era benefits winding down, the number of Texans without health care coverage could grow.
Across the state, families who rely on Medicaid or Affordable Care Act marketplace coverage are bracing for big shifts in how they qualify for coverage, how much they pay, and whether they’ll even be eligible to stay insured at all.
Here’s what to know about Medicaid and ACA-related changes coming to Texas in 2025 and who’s most likely to feel them.
Will Medicaid eligibility rules change in Texas?
Yes, but not as drastically as in other states.
Texas never expanded Medicaid under the Affordable Care Act, which means the state already has stricter limits on who qualifies.
Right now, most adults in Texas can’t get Medicaid unless they are pregnant, have a disability, are over 65, or care for a child and make less than $300 a month for a family of four.
Because Texas didn’t expand Medicaid, it’s insulated from some of the new national work requirements included in the recent federal tax and spending bill.
But even so, roughly 200,000 Texans could lose Medicaid coverage in 2025, according to estimates from KFF, a national, non-profit health policy research group. Many of those losses are expected to come from increased documentation and income checks, not outright ineligibility.
How will changes to the ACA marketplace impact Medicaid-eligible Texans?
In Texas, the ACA marketplace has helped fill the gap for people who don’t qualify for Medicaid but still can’t afford full-price insurance.
But in 2025, many of these families may see:
- Premiums go up, especially if Congress lets temporary ACA subsidies expire.
- More red tape when enrolling or renewing.
- Shorter enrollment windows, making it easier to miss deadlines.
If the enhanced ACA tax credits created during the pandemic expire as scheduled at the end of 2025, monthly premiums could jump significantly.
For example, a Texan earning around $22,000 a year could see their premium increase from $0 to more than $60 per month, based on projections from the Center on Budget and Policy Priorities.
What’s changing with enrollment and documentation?
Even for Texans who still qualify for Medicaid or ACA subsidies, staying covered will become more complicated.
Starting in 2025:
- Automatic re-enrollment will end for most ACA plans.
- More proof of income will be required, especially for anyone getting premium assistance.
- The open enrollment period will be one month shorter.
- Starting in 2026, year-round enrollment for low-income enrollees under 150% of the federal poverty level will end.
Will immigrants be blocked from getting coverage?
Some immigrants who are legally present in the U.S. will no longer be allowed to buy health plans through the ACA marketplace.
This includes:
- DACA recipients
- Asylees
- People with Temporary Protected Status (TPS)
- Refugees
That policy change could affect thousands of mixed-status families in Texas, where immigrant communities often rely on marketplace coverage to supplement limited access to public health care.
What does this mean for health care access in Texas?
Texas already has the highest uninsured rate in the country, and these changes could push that number even higher.
If families lose Medicaid and can’t afford ACA plans without subsidies, many may be forced to go without insurance. That could lead to:
- More strain on emergency rooms and public hospitals
- Delayed or skipped care, especially for chronic conditions
- Higher insurance premiums for those who remain covered, as insurers spread the cost across a shrinking pool
Experts at KFF and the Center on Budget and Policy Priorities warn that the cumulative effect of these policies could cause the largest coverage loss since the ACA was first passed.
What can families do now to prepare?
If you rely on Medicaid or ACA coverage in Texas, here’s how to get ahead of the changes:
- Review your income and documentation now so you’re ready to re-enroll.
- Update your contact info with HealthCare.gov and Texas Medicaid, so you don’t miss renewal notices.
- Talk to a navigator or enrollment counselor if you’re unsure about your eligibility.
- Keep an eye on news from Congress, there’s still a chance the ACA subsidies could be extended, but no guarantees.
